Safety and Health Management System for Preventing Musculoskeletal Disorders in Nursing Homes Sukhvir Kaur and John Newquist
Cost of Workplace Injuries/Illnesses Large amount of physical, financial, emotional hardship
WHAT DO ACCIDENTS COST YOU? Unseen costs can sink the ship! Direct - Insured Costs Just the tip of the iceberg Indirect - Uninsured, hidden Costs - Out of pocket 1. Time lost from work by injured employee. 2. Lost time by fellow employees. 3. Loss of efficiency due to break-up of crew. 4. Lost time by supervisor. 5. Training costs for new/replacement workers. 6. Damage to tools and equipment. 7. Time damaged equipment is out of service. 8. Loss of production for remainder of the day. 9. Damage from accident: fire, water, chemical, explosives, etc. 10. Failure to fill orders/meet deadline Unknown Costs - 1. Human Tragedy 2. Morale 3. Reputation
Creating a strong S&H Culture Positive workplace attitudes from the president to the newest hire. Involvement and buy-in of all members of the workforce. Mutual, meaningful, and measurable safety and health improvement goals. Policies and procedures that serve as reference tools, rather than obscure rules. Personnel training at all levels within the organization. Responsibility and accountability throughout the organization.
OSHA Safety and Health Program Management Guidelines (1/26/89) Management Commitment Employee Involvement Worksite Analysis Hazard Prevention / Control Training (Evaluation / Improvement)
Pre Rule: I2P2 Proactive program to find and fix hazards Effective in reducing injuries, illnesses, fatalities 34 states and many nations around the world have such requirements
Evidence Injury and illness incidences lowered by 9 percent to more than 60 percent in eight states where either program required or incentives through workers comp Fatality rates in California, Hawaii and Washington, with their mandatory injury and illness prevention program requirements, were as much as 31 percent below the national average in 2009.
Cal OSHA 8CCR 3203 Injury and Illness Prevention Program Model Program Elements Responsibility Compliance Communication Hazard Assessment Accident / Exposure Investigation Hazard Correction Training (Instruction) Recordkeeping Implement and Maintain Program
VPP s Compelling Evidence Successful because its replicable! On average for CY 2010, VPP participants are: 47% below the Total Recordable Cases of Injuries and Illnesses (TCIR) rate 56% below the Days Away from Work, Restricted Work Activity, or Job Transfer (DART) rate Avoided an estimated 9,023 TCIR injuries and 6,310 DART injuries when compared to expected results within their respective industries
Research demonstrates that such programs are effective in transforming workplace culture; leading to reductions in injuries, illnesses and fatalities; lowering workers compensation
Benefits Reduced employee turnover, improved morale Fewer injuries among workers Reduced workers compensation costs Resident injury reduction Increased admissions from improved PR Overall better resident care Reduced risk of OSHA inspection & penalties VPP sites are exempt from programmed inspections
A Process for Protecting Workers OSHA Guidelines: Ergonomics for preventing MSDs in Nursing Homes Provide management support Involve employees Identify problems Implement solutions Address reports of injuries Provide training Evaluate ergonomic efforts
Provide Management Support Develop clear goals Assign responsibilities to staff Quality assurance Competent in equipment usage Enforcement/discipline of facility policy and procedures Provide necessary resources Ensure that responsibilities are fulfilled
Employee Involvement Employees: The Real Champions for the Process Results in: Increased problem-solving capabilities Enhanced worker motivation and job satisfaction Greater acceptance of changes
Employee Involvement Establish a Lift Committee Participate in selection, training, evaluation of equipment Involved in developing the ergonomic process
Hazard Analysis: Identify Problems Review Injury and illness logs Workers compensation records Reports of problems Accident reports Insurance company reports Talk with employees Observe jobs/workplace
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Facility Injury/Illness Rate DART Rate for all site injuries/illnesses: Total # of cases with lost workdays or restricted days Multiply by 200,000 Divide by total employee hours Comparing it to the national average: BLS DART Rate for 2010: 5.6 BLS Resident Handling Incident Rate (RHIR): 9.6
Facility Musculoskeletal Disorder (MSD) Rate DART Rate for MSDs: Total # of MSD cases with lost workdays or restricted days Multiply by 200,000 Divide by employee hours (only department hours if calculating MSD rate for the department) Severity Rate: Total # of lost + restricted days Multiply by 200,000 Divide by employee hours
Provides: Trend Analysis How many MSD injuries are occurring Where, when, how they are occurring Easier to figure out why they are occurring Trend over the years Look for patterns 20
RHIR & RHSR for Past Three Years Site DART Rate: 2011: 8.8 2010: 8.9 2009: 7.9 Resident Handling Incident Rate 2011: 14.7 2010: 4.3 2009: 20.3 BLS National Avg.: 2011: 5.3 2010: 5.6 2009:5.6 Resident Handling Severity Rate 2011: 1860.3 2010: 769.9 2009: 203.0 21
Accident / Incident Investigations Seek out root causes of the accident or event not fault finding Address "near miss" incidents. A system to analyze trends review of injury/illness experience hazards identified through inspections employee reports accident investigations, and/or other means
Accurate Recordkeeping Mechanism for reporting MSDs and their signs and symptoms Accurate documentation of injury reports Intervention and access to health care professionals
Hazard Prevention and Control Hierarchy of Controls Engineering controls Administrative controls Work Practice controls Personal protective equipment.
Resident Assessment Decision Logic Size and weight Level of assistance required Resident s rehabilitation needs Need to restore resident s functional abilities Ability and willingness to cooperate Medical conditions impacting choice of methods
Implement solutions Mechanical assist devices help reduce injury by avoiding unnecessary manual transfers Eliminate the need to manually lift or move residents Sufficient quantities Readily available for use Sufficient accessories Maintained in good working condition
Implement Solutions Reassessing need Thorough training on equipment and proper work practices Lift teams Space constraints- movement and operation of equipment Preventative maintenance Early reporting and treatment of injuries
Alternative to Manual Lifting Providing an alternative to manual resident lifting in nursing homes is the primary goal of the ergonomics process and of the OSHA guidelines OSHA recommends that manual lifting of residents be minimized, and eliminated when feasible
Training To be able to recognize potential ergonomic issues Understand measures available to minimize risk of injury To recognize MSDs and early indications of MSDs Site s ergonomic policy -work practices and use of equipment Injury/illness reporting process
Evaluate Ergonomics Efforts Open lines of communication Interview employees, ask suggestions Observe workplace conditions Track improvements- performance markers: Decrease in incidence and severity of injuries Decrease in OSHA recordables Increase in employee satisfaction Decrease in employee turnover
Resources Safety and Health Management system e-tool: http://www.osha.gov/sltc/etools/safetyhealth/index.html Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders http://www.osha.gov/ergonomics/guidelines/nursinghome /final_nh_guidelines.pdf Small Business Handbook: http://www.osha.gov/publications/smallbusiness/smallbusiness.pdf
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